Transcript report here - SCOTT D Miller

CHILEAN ADAPTATION AND VALIDATION OF THE OUCOME RATING SCALE (ORS)
PROCEDURE
I N T R O D U C TION
-Spanish-English translation of test ORS
- Review by a panel of experts therapists and
methodologists.
- Spanish-English retranslation
- Final version Validation by Duncan and Miller
- Retranslation into Spanish.
Based on Eysenck`s studies (1952), a change in the research of the several
theoretical approaches in psychotherapy has started, beginning to focus on
the effectiveness of the psychotherapeutic process.
"Instead of assuming that the right process leads to favorable results, it is
necessary to use these results to build and guide the therapeutic process”.
(Duncan and Miller, 2000)
DIFFICULTIES
Loss of much of the sample due to:
-High resistance of therapists, supervisors and institutions
because of the fear of being evaluated by the patient.
- Implementation process seems long and tedious.
- Neglect of the material from the therapists.
- Therapy abandonment.
- Some consent letters were not signed.
In this context, the need of developing tools to assess the client’s subjective
experience of change in the treatment process comes out. Based on what has
been already stated, the Outcome Rating Scale (ORS) was created by
Duncan and Miller in 2000, based on the Outcome Questionnaire (OQ-45.2).
OUTCOME RATING SCALE (ORS)
Assessment Tool more "detailed": Assesses
the the client’s
subjective experience of change in the
treatment process in 30 minutes
45 items
Manages to be precise in identification of
clinical risk factors such as suicide, alcohol
or drugs
Screening instrument: assessing the
client’s
subjective experience of
change in the treatment process in 1
minute
4 items
Does not measure or attempt to
identify risk factors such as suicide,
alcohol or drugs. Therefore, it may be
less accurate in detecting these kind
of symptoms.
Valid and reliable in U.S.A.
More likely to apply and integrate
into
the
chilean
psychotherapy
context
It is designed for a basic level of
reading and understanding, being
easy to use for adult population.
The correction is very short (1 min)
and the results are immediately
available to discuss with the patient,
so that the instrument may become a
clinical tool.
The correction takes time (30 min.), So
results are not immediately available for
use in therapy.
thesis team by validating
SRS test (in contrast to test IAT) to facilitate
sample collection.
- Contact with therapists (belonging to
mental health centers and independent)
SAMPLE
RECOLECTION
MONITORING OF
SAMPLE
IMPLEMENTATION
PROCEDURE
-Delivery of 250 kits and training to therapists.
Content folders:
- Patient´s authorization letter
- Guideline for use of tests
- 10 Copies test ORS
- 10 copies SRS test
- 3 copies IAT test
- 3 copies test OQ-45.
STATISTICAL ANALYSIS
OUTCOME QUESTIONNARIE (OQ-45.2)
Some of their items are somehow difficult
for adult population.
-Alliance with another
FINAL SAMPLE(n:22)
The advantages and disadvantages of both tests are:
Valid and reliable in U.S.A. and Chile
Unlikely to apply and integrate into the
chilean psychotherapy context
VALIDATION
ADAPTATION
What's happening in our country?
Within the tests validated in Chile to assess the client’s subjective experience
of change in the treatment process , one of them is the questionnaire OQ45.2. This questionnaire, which was validated in 2002, by De La Parra, Von
Bergen and Del Rio, has been used since then. Managing to be precise in
the evaluation of the client’s subjective experience of change in the treatment
process.
However, it is necessary to validate an instrument in Chile acting as a
"screening" on the client's perception of change in the treatment Process. It
allows greater implementation feasibility, especially in the chilean context of
psychotherapy in both private and public institutions.
Counting on these fast and simple tests, they allow minimal impact on
process of psychotherapy and also allow better integration of research to the
psychotherapy.
- Reliability analysis (Cronbach Alpha)
- Validity Analysis
Content Validity
Construct validity: correlation interescale
Convergent validity: Pearson correlation with OQ-45.2.
Evolution of time-varying analysis
RESULTS
Sample comportament
 There were not statistically significant differences between the ages of men 35.12 (M: 34.2, DE: 11.9) and
women 34.71 (M: 31.9, DE: 10.3) who participated in this research ( p = 0.446).
The scores distribution is clustered around
half the scale (score 5 on a scale from 0 to10),
with standard deviations of 2.5 points. It is
observed an increase in scores through the
applications and the stabilization of themselves,
specifically from the fifth application
Tabla 1: Índices de Confiabilidad test ORS
Reliability
The total reliability of the instrument was calculated through
Alpha Cronbach´s technique. The results indicate appropriate
reliability ranges with a value of 0.905 for the 1st application.

Table 2: Inter-Scale Correlations for the First and Fifth Application
Construct validity (Inter-Scale Correlations)
The correlation of the different scales was calculated
as a measure of homogeneity in the test. The
results show positive significant correlations with
p <0.05 among all scales, ranging from rxy =. 605 until
rxy =. 995. On the right side of the page, the correlations
Inter-Scale for the1st and the 5th application.
Table 3: Pearson correlation between ORS and OQ-45.2 for the Fist Aplication
OBJECTIVES
I. General Objetive
To adapt and validate the assessment tool results (ORS) to use in the
Chilean population.
II. Specific Objectives
1. To adapt the ORS Items to the social and cultural reality from a Chilean
linguistic and semantic point of view.
2.To assess the reliability of the adapted instrument.
3.To assess the validity of the adapted instrument:
Content Validity
Construct validity
Concurrent validity
Sensitivity to change
M E T HO D
I. Methodology
This is a quantitative psychometric research. The sampling strategy was nonprobabilistic and accidental. It was used a sample of therapeutic processes
among Chilean patients from the metropolitan area. They were all over 18
years old, from both sexes and were consulted in public or private
psychological institutions. In this regard, therapeutic processes were
evaluated in relation to the patient, not patient-therapist dyads. The final
sample was from 22 participants (8 men and 14 women).
People who didn't authorize the use of their results in the study or those
who were not trained to answer the test, because of disturbances, psychotic
episodes, or addictive disorders, were excluded from the sample. There was
also another exclusion criteria, which consisted in having previously
consulted to that therapist. All subjects voluntarily agreed to participate in
the study, obtaining informed consent and approval of relevant ethics
committees of the institutions concerned.
IV. Procedure
The subjects completed the ORS and OQ-45.2 (used as a contrast measure).
The psychometric characteristics of ORS and its correlation with the OQ-45.2
were evaluated through statistical analysis of the results.
Fig. 2: Procedure
on all scales
Tablle 4: Comparisson between ORS validation in USA and Chile
Concurretnt validity (with respect to OQ-45.2)
The analysis of the association between the ORS scores and
OQ-45.2 are shown in the first application. For this,
measurements with the correlation test and Pearson
correlations were carried out and correlations were obtained.
According to the reduced N (6), for the tenth application, it
was chosen the use of Spearman's indicator of
association and the ones obtained were in the scales:
Individually and With Others.
Sensitivity to change over time
There are differences in measurements for intra –individuals
for each dimension. That is why, it can be stated that the test is
sensitive to change in different scales over time.
CONCLUSION
The results confirm that:
- The ORS scale is adapted to the Chilean reality from a linguistic and semantic point of view.
- The scores showed an evolution from the 1st to the 5th session, where it reaches the highest score, and then
leveled off at around 7 points from the seventh session onwards.
- ORS scale in this application is reliable (Cronbach's Alpha 0,905-0,954)
- The ORS provides a level of content construct and convergent validity, (between 0.5 and 0.58) respect to the
OQ -45.2 and it is sensitive to change over time.
- The information obtained is consistent with the results obtained by the authors who studied reliability and validity
of the ORS test in the American population. (0.93 reliability and concurrent validity 0.5 and 0.69)
- Therefore, it is possible to conclude that the ORS is a valid instrument to be used in the Chilean population.
LIMITATIONS
- The sample is not too large, and this may affect the fact that the correlation with the OQ-45.2 is not significant
for all scales in all applications.
DIFFICULTIES
- The battery of tests requires a long time to apply.
- The therapists’ resistance to use the test
because
it
might
affect
the
therapeutic
alliance.
PROPOSALS FOR THE FUTURE
- It is suggested to continue with this study, increasing the amount of the sample, implementing methods to reduce
experimental mortality. Also to perform other tests to enhance the validity of the instrument, such as a factor
analysis ,to take more details and correct the lower correlations found with the OQ-45.2.
Cecilia Donoso Guillen- María Alejandra Grez Valdés
Psychology School, Universidad Gabriela Mistral, Chile